Archive for October 13th, 2017

13
Oct
17

Pharmaceutical Television Commercials – Ethical or Unethical

Pharmaceutical Television Advertisements – Ethical or Unethical

What is more American than the pharmaceutical companies? A Mega-company’s Board of Directors tells their shareholders that they are going to spend hundreds of thousands on research to develop a new drug, then spends thousands of dollars and several years on bureaucratic red tape to get their drug approved by the Food and Drug Administration. After the approval, there is the initial announcement of their new medicine, with spending of more tens of thousands of dollars to market to physicians, hospitals and directly to consumers. In this way, the pharmaceutical can feel justified in passing their outrageous expenses unto unsuspecting patients. Now, that is a true American success story.

Television As A Way To Market Directly to Patients

I like television commercials as much as the next guy, which means not very much. The exception is during the Super Bowl, in that case, it is the best part of the whole experience. Save this “Hyper Bole”, I would rather record a program, then skip through the commercials. But, some commercials that I do not always skip are the pharmaceutical commercials. Pharmaceutical commercials on television are a relatively new phenomenon. When these direct-to-consumer ads were first approved in 1997, the pharmaceutical companies started slowly and carefully, but, soon the industry exploded. Pharmaceutical companies now spend more than $5 billion per year on television commercials. Only New Zealand and the USA allow direct to consumer advertising of pharmaceuticals. I guess the drug companies want us Americans and New Zealanders to make our own diagnosis and pick their treatments based on their advertisements.

 

I do like some of the drug commercials. The ads are professionally done, they are mostly truthful and they announce the possible side effects (they are all said in a bullet-like rapidity and usually ends with “including death”). There are some ads that are actually good. For example, there is one commercial for an asthma medicine which shows a giant bear standing behind a man, squeezing the man’s chest while everyone looks on. The on-lookers seem not to be disturbed by the proximity of this giant bear or for the health of the man that is being bear hugged. Also, the bear releases the man once the aerosol is dispersed. It makes one wonder is this as asthma medicine or a bear spray? Maybe it is both.

The other commercial that is not too obnoxious is an ad for Diabetes. There is this happy, pudgy guy, dancing to an Earth Wind and Fire song, pouring out olive oil on the kitchen floor, trying to pull a lazy bassett hound and mowing a lawn in an oblong circle. They are fun to watch. (It is the music that makes the commercial).

But, then there are commercials that I am not sure how it sells the product. There are multiple examples of these, but the classic example is an erectile dysfunction ad – why are the couples sitting in separate single-person-tubs outdoors? Is that supposed to be sexy? Or relaxing?

How Expensive are these advertised medications?

When you spend thousands of dollars making a commercial and then buy time to show your commercial on television, you know that the medication they are plugging is going to be very expensive. You know it is not a company that is selling generic medications. But how expensive are these medications? Patients, or consumers as the Pharmaceutical companies refer to them, have no idea how much these medications cost and for the vast majority of physicians, also, have no idea either. I, only recently, have been able to find out the price of medications by employing an App called “GoodRx”, they also have a website.

GoodRx gives a list the 6 lowest prices of the medication at local pharmacies. By employing this App, you can instantly get idea how expensive a medicine is – without calling a pharmacist. This App, also, makes one aware that no pharmacy is consistently cheaper than another. Trying to figure out how much something costs and where it is cheapest on your own is a total crap shoot. I would recommend the GoodRX App if you are truly interested in pharmaceutical prices.

Let us go back to an example of eczema, which there is a new TV ad. A medicine that treats this condition – a moderate strength corticosteroid like triamcinolone, a 60 g tube costs less than $20. This will take care of most eczema. But, a newly advertised product, Eucrisa, costs $604 – $628 per month (this is based on having a coupon and polling the lowest-priced 6 local pharmacies – so, the price can be higher). So why get Eucrisa? Who knows. Is it 300 times better?

How prevalent is television pharmaceutical ads? Below is a list of commercials I saw on television in a couple of days. Listed is the product, the condition it treats and the cost per month (based on GOODRx 6 lowest prices with coupon). (Maybe you have seen one of these).

Taltz (Ixekizumab) Psoriasis $14,713 – $15,953

Stelara (ustekinumab) Psoriasis, Crohn’s Disease $9,739 – $10,196

Cosentyx (Secukinumab Psoriasis $9,036 – $9,460

Entyvio (Vedolizumab) Ulcerative Colitis $5,570 – $5,927

Victoza (Liraglutide) Diabetes Mellitus $836- $870

Eucrisa (Crisaberole) Eczema $604 – $628

Tresiba (Insulin degludec) Diabetes Mellitus $462 – $483

Entresto (Sacubitril/Valsartan) Congestive Heart Failure $453 – $471

Xarelto (Rivaroxaban) Arial Fibrillation, Deep Venous Thrombosis $407 – $423

Eliquis (Apixaban) Atrial Fibrillation, Deep Venous Thrombosis $407 – $423

Spiriva Respimat (Tiotropium) Asthma $389 – $402

Myrbetriq (Mirabegron) Urinary Incontinence $340 – $341

 

It is not unethical what the Pharmaceutical companies are doing, right? That is the $5 Billion question.

Unethical Issues

If the Television advertisements marketing directly to consumers isn’t totally unethical, there are some which are unequivocal, like Martin Shrekli increasing the price of Daraprim, the only antibiotic to fight a certain infection by 5,000%, Daraprim used to cost $750, but after Shrekli took over the company it is now according to Good Rx with coupon $45,909 – $48,048 for 60 tablets).

Other issues that are clearly unethical: 1) taking old time generic medications, getting them re-patented and mark up the price by 5,000 times. Examples: 1) colchicine for gout, a medicine as old and cheap as aspirin (todays cost according to Good Rx with coupon $80 – $179 for 30 tablets), 2) tetracycline -used to be one of the oldest and cheapest antibiotics, (Good Rx with coupon $292 – $575 for 60 tablets) and 3) albuterol inhalers used to be $5-$20, now $57 – $62 for one inhaler according to GoodRx with coupon).

The next issue is kind of unethical – it is taking two generic medications and combining them into one pill and giving that a new patent. (It is similar to what pharmaceuticals have been doing for many years: when a branded medicine is about to have its patent expire – pharmaceutical companies tweak something to the medicine – delivery system, changing a drug to extended release, changing to the active molecule, etc, then, they can have a new patent for the same medicine.) The two best examples of combining two generic medicines into one pill and then charging and arm and a leg for it are Duexis and Namzaric (not to be confused with Narnia).

Duexis is a medicine that is a combination of Ibuprofen (the same medicine as Advil), and Famotidine (Pepcid) an old stomach medicine. This “new medicine” will decrease the incidence of ulcers by 50% than by taking Ibuprofen alone. But if you bought each one separately, one can get 90 tablets of 800 mg Ibuprofen for $10 at WalMart and Famotidine 20 mg, 60 tablets at WalMart for $4.00. So how much should you pay for Duexis which is Ibuprofen 800 mg and Famotidine 26.6 mg? $100? $200? How about $2,313 – $2,422 for 90 tablets? If you were an insurance company with drug coverage, would you approve this medicine? Of course not.

Namzaric is an Alzheimers medication. It is a combination of the generic medicines: donepezil (Aricept) and Mematine (Namenda) in one pill. Generic Donepezil 10 mg, 30 tabs can be bought for a low as $9.05 – $54 (GoodRx with coupon), and memantine 10 mg 60 tabs can be bought for $23 – $123 (GoodRx with coupon). For Namzaric 28/10 (Mematine/Donepezil), it costs $405 – $421 for 30 tabs. But, the pharmaceutical company will argue that it is does not contain generic Namenda but its “newer” Namenda XR and that one can buy Namenda XR at exactly the same price as Namzaric. Oh.

American Pharmaceutical companies seem to typify the American business environment: Poor people pay outrageous prices so Mega companies can make millions of dollars in profits every quarter. My message is the next time a pharmaceutical television ad comes on, whip out your smartphone, and check out how much that drug costs on GoodRx.

 

 

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